Head & Neck/Plastic & Reconstructive Surgery

Cutting-Edge Treatment for Improved Survival and Quality of LIfe

Partners In Practicewww.roswellpark.org/partners-in-practice

medical information for physicians by physicians

The Department of Head & Neck Surgery

Plastic & Reconstructive Surgery and the Division of

Dentistry/Oral Medicine & Maxillofacial Prosthetics

Elm & Carlton Streets | Buffalo, New York 14263www.RoswellPark.org/rpmd

716-845-RPMD (716-845-7763)

A National Cancer Institute-Designated Comprehensive Cancer CenterA National Comprehensive Cancer Network Member

A Blue Distinction Center for Complex and Rare Cancers®A Blue Distinction Center for Transplants®An ANCC Magnet®-Designated Hospital

THAT’S WHY AT’S WHY AROSWELL PARK PWILL NEVER STOP FIGHTING

WE CAN’T LET CANCER WIN

28193 (9/14)

Confer with an RPCI Physician / Request Information / Refer a PatientTo connect with an RPCI physician, request information, or refer a patientMonday-Friday, 8 a.m.-8 p.m. (excluding holidays), call 716-845-7763 oremail rpmd@roswellpark.org.

1. Ahmed Abdelhalim, MDNeuroradiology - Head & Neck (Pediatric)

2. Ronald Alberico, MDNeuroradiology - Head & Neck (Adult)

3. Hassan Arshad, MDHead & Neck / Plastic & ReconstructiveSurgery / Photodynamic Therapy

4. David Casey, DDSMaxillofacial Prosthetics

5. David Cohan, MD, FACSHead & Neck Surgery

6. Vishal Gupta, MDHead & Neck Surgery*

7. Wesley Hicks, Jr., MD, DDS, FACSHead & Neck / Plastic & Reconstructive Surgery

8. Moni Abraham Kuriakose, MD, BDS, FDSRCS, FFDRCS, FRCS Ed, FRCS,Head & Neck / Plastic & Reconstructive Surgery

9. Dominick Lamonica, MDNuclear Medicine

10. Anthony Lister, DDSDental Oncology / Dentistry

11. Robert Lohman, MDPlastic & Reconstructive Surgery

12. Mihai Merzianu, MDPathology

13. Wong Moon, MD, FACSPlastic & Reconstructive Surgery

14. Cemile Ozturk, MDPlastic & Reconstructive Surgery**

15. Anurag Singh, MDRadiation Oncology

16. Paul Tomljanovich, MDHead & Neck / Plastic & Reconstructive Surgery

17. Philip Williams, DDS, GPRDental Oncology / Dentistry

18. Yujie Zhao, MD, PhDMedical Oncology

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Meet the Head & Neck Team

Marks of DistinctionBlueCross BlueShield of Western New York has named Roswell Park a Blue

Distinction Center for Complex and Rare Cancers® for providing superior

care for 13 types of cancer, including head & neck cancer and medullary

& anaplastic thyroid cancer. We are one of only four centers in New York

State to have earned this designation.

Roswell Park Cancer Institute (RPCI) plays a key role in developing the

National Comprehensive Cancer Network (NCCN) guidelines that identify

the best ways of preventing, detecting, and treating specific types of cancer.

Based on scientific data, the NCCN guidelines are the most widely used

standards for cancer care. Two RPCI physicians who treat patients with

head & neck cancer and/or thyroid cancer—Wesley Hicks, Jr., MD,Chair of Head & Neck / Plastic & Reconstructive Surgery / Dental Oncology

& Maxillofacial Prosthetics, and Dominick Lamonica, MD, Director of Nuclear Medicine—are among the experts who develop the NCCN

guidelines. Visit www.nccn.org for more information.

Benefits of a High-Volume CenterWith more than 10,000 visits by head & neck patients every year, RPCI’s Head

& Neck Center is a high-volume center that focuses exclusively on cancer. We

see many rare cancers on a regular basis. Studies show that that experience

translates into better outcomes for patients. Most recently, a study published

in the March 2013 issue of Cancer concluded that patients with advancedhead and neck cancers who were treated at high-volume centers like RPCI

survived longer than patients treated elsewhere.

RPCI is also a high-volume center for both thyroid and parathyroid surgery.

*(in conjunction with Drs. Arshad, Cohan, Hicks, and Kuriakose) **(in conjunction with Drs. Lohman, Moon, and Tomljanovich)

2Refer A Patient

Customized treatment, planned and delivered by a multidisciplinary team of experts Treating cancers of the head and neck (upper aerodigestive tract and thyroid gland)

can be extremely challenging. Tumors may be difficult to access; treatment may

alter the patient's appearance significantly or impair speech, swallowing, and other

functions; and the patient must be monitored closely over the long term, because

the disease carries a high risk of recurrence.

RPCI’s comprehensive Head & Neck / Plastic & Reconstructive Surgery / Dental

Oncology and Maxillofacial Prosthetics Center brings together a multidisciplinary

team of specialists, all focused exclusively on cancers of the head and neck,

to design a customized treatment plan that will meet both the medical and

medical-related needs of each patient. Those needs may include surgery

(including neurosurgery, microsurgery, and plastic and reconstructive surgery),

dentistry, radiation oncology, medical oncology, endocrinology, speech therapy,

voice restoration, the creation and fitting of maxillofacial prosthetics, nutrition

education and support, and pain management. All services are available in one

location—RPCI—providing greater convenience for the patient and their family.

The goal: cure or extended survival, optimum disease control, and the highest possible

quality of life. The Center looks beyond cure to total rehabilitation.

Illustration courtesy of NCI and Terese Winslow

• Oral cavity and lip cancer

• Pharyngeal cancer

• Laryngeal cancer

• Nasal cavity and paranasal sinus cancer

• Salivary gland cancer

• Thyroid and parathyroid cancer

• Eye cancer

• Skin cancers of the face, scalp, and neck

• Skull base tumors

Factors that increase the risk of head and neck cancer

• People who drink alcohol or use tobacco (either smoked or chewed)are at greatest risk for head & neck

cancer. The risk is multiplied significantly

in patients who do both.

• Infection with the Human Papilloma Virus (HPV), a common sexually transmitted disease, is also a significant

risk factor for oropharyngeal cancers.

Roswell Park's Head & Neck Team Treats These Cancers:

Call 1-800-ROSWELL (1-800-767-9355) to arrange consultations and/or second opinions or to refer patients.

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Factors that increase the risk of thyroid cancer

Although causation has not been identified for

most cases of thyroid cancer, some factors may

put patients at higher risk for the disease, including:

• Insufficient iodine in the diet• Radiation exposure, either from medical treatment during childhood or fallout from

nuclear plant accidents or nuclear weapons

• Age: Thyroid cancer occurs most frequently in women in their 40s or 50s and in men in

their 60s or 70s.

• Gender: Women are three times more likelythan men to develop thyroid cancer.

• Family history: In very rare cases, thyroid cancer is caused by an inherited gene mutation.

In such patients, prophylactic thyroidectomy

can help prevent the disease from occurring.

RPCI’s Clinical Genetics Service can help

patients understand the likelihood of an associated

hereditary condition and determine if genetic

testing is warranted. Patients may call

1-877-ASK-RPCI to set up an appointment, or providers may fax patient information

to the Clinical Genetics Service, at716-845-5720. Most people who develop thyroid cancer do not have

any of these risk factors.

For High-Risk Patients, Better Detection of Oral CancerAFV Screening at Roswell Park

Many patients do not experience symptoms of oral cancer until the disease has spread

beyond the mouth to the neck, at which point the cure rate is lower and the risk of

treatment-related comorbidities is higher. Screening high-risk patients increases the

likelihood of catching the disease at an earlier and more treatable stage.

RPCI has a dedicated oral cancer screening service for high-risk patients. It employs

autofluorescent visualization (AFV), using blue fluorescent light to identify abnormal

areas of the mucosa that should be biopsied. RPCI is one of few institutions nationwide

equipped for this detection method.

Who is eligible for screening?• Anyone who has a suspicious oral lesion (white or red patch or ulcer lasting more

than two weeks).

• Anyone who has recently received a diagnosis of oral cancer but has not begun

treatment.

• Anyone who has been treated previously for head & neck cancer and who has

been disease-free for six months. Regular screening is critical for patients who

have been treated previously for oral cancer, because the initial cancerous lesion

is often surrounded by premalignant lesions that may eventually become malignant.

Nearly a third of patients develop a second cancer after treatment for the first.

For more information about Roswell Park’s screening program for patients at high risk for oral cancer, contact the Early Oral Cancer

Detection and Diagnosis Screening Program, at 716-845-5972.

Two-thirds of patients with oral cancer are diagnosed when the diseaseis in an advanced stage and more difficult to treat.

Pathology Specialists Ensure Diagnostic Accuracy For Pinpointing the Best Treatment Options

Diagnostic accuracy is essential for selecting the most effective and least invasive

treatment plan. Correct grading and staging of the disease also helps identify patients

with more aggressive disease, for whom intense therapy options may be appropriate.

Early detection provides the best chance for cure.

Specialized pathology expertise is critical in cases involving emerging cancers, such

as Human Papilloma Virus (HPV)-related carcinoma; rare tumors, such as salivary gland

neoplasms; or in cases of lymphomas involving the head and neck. Because Roswell

Park focuses exclusively on cancer, the Pathology team is skilled in identifying and

characterizing rare cancers that most pathologists may never encounter. A wide variety

of ancillary studies is available to the team to help achieve the correct diagnosis and

identify the best management plan for each patient.

“When treating cancer, youwant to make sure that youhave not only the correct diagnosis, but also the correctgrading and staging, whichcan completely change prognosis and disease management. Because wefocus on cancer alone, wehave developed special expertise in the field.”

— Mihai Merzianu, MDDepartment of Pathology

& Laboratory Medicine

Roswell Park's additional diagnostic capabilities include:• A Flow and Image Cytometry Facility, recognized asone of the first and finest in the nation, specializing in

leukemia and lymphoma. Within hours, specialists at this

facility can confirm a diagnosis and identify specific

types or subtypes of disease.

• Fluorescence in situ hybridization (FISH), whichmakes it possible to spot chromosomal anomalies.

Both types of testing provide precise prognostic information.

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Skull Base SurgerySome patients may be candidates for expanded endoscopic endonasal

surgery, a minimally invasive approach that provides access to the

tumor site through the nose. Used for the treatment of meningiomas and

benign pituitary tumors as well as selected malignancies, the procedure

combines the expertise of surgeons from RPCI’s Head & Neck and

Neurosurgery departments, who work together in both developing the

treatment plan and performing the surgery.

An endoscope introduced through one nostril provides images of the

surgical site, while surgical instruments introduced through the other

nostril enable the head & neck surgeon to open the area leading to

the tumor. The neurosurgical team, with assistance from the head and

neck surgeon, resects the tumor.

Expanded endoscopic endonasal surgery provides the neurosurgeon

with an excellent view of the tumor site as well as critical structures

nearby, and provides a wider space to achieve complete removal.

Using this technique, the RPCI team has successfully treated many

patients throughout the Northeast and near Midwest.

“With the aid of image-guided surgery and advances intumor-access procedures, it is rare for a head and neckcancer to be considered unresectable.”

— M. Abraham Kuriakose, MD, BDS, FDSRCS, FFDRCS, FRCS Ed, FRCS

On multiple occasions, RPCI’s lateral skull base surgical team has successfully resected tumors that were previously characterized as unresectable.

Head & Neck SurgeryAdvanced Techniques Improve Disease Control, Speed Recovery, Preserve Quality of Life

Our surgeons have extensive experience in lateral skull base surgery and have performed a

large number of procedures resecting tumors that were previously characterized as unresectable.

In select cases, RPCI surgeons also offer modified facial translocation, using both open and

endoscopic techniques with an image-guidance system.

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RPCI’s Head & Neck surgical team takes the most effective but least invasive surgical approach to achievecomplete tumor removal while minimizing side effects. When highly invasive surgery is the only alternative,our head & neck surgeons work closely with our plastic & reconstructive surgeons to provide optimal function and appearance.

Skull Base Surgery with Facial TranslocationAnterior skull base tumors located outside the scope of expanded

endoscopic endonasal surgery are especially difficult to access. In the

past, excision often required permanent removal of the jaw or other sec-

tions of the skull, resulting in poor long-term quality of life for the patient.

Such tumors can be treated via lateral skull base surgery with facial

translocation. At RPCI, the procedure is provided by a team of surgeons

from Head & Neck Surgery, Neurosurgery, and Plastic & Reconstructive

Surgery. This approach is used to achieve:

• Complete removal of the tumor • Protection of critical neural and vascular

structures adjacent to the tumor site• Preservation of function• Optimal cosmesis

To gain access to the tumor site, in essence head & neck surgeons create

a hinged “door” by splitting the mid-face. This “door” can swing open to

allow neurosurgeons to reach the tumor, and then close when the excision

is complete. The team’s plastic & reconstructive surgeons then complete

the surgery to provide the best postsurgical appearance. This creates

a wide surgical field for greater precision. It also allows the benefit of

immediate reconstruction, eliminating the need for additional surgery.

Pre-Op

Post-Op

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Plastic & Reconstructive

SurgeryA Suite of Options for Any Region of the Body

Among other procedures, they offer:• Free flap surgery using microvascular techniques, which allows the transfer of

tissue from multiple body regions to the operated site. This enhances the patient’s

ability to return to pretreatment form and function.

• Breast reconstruction, including immediate (at the time of mastectomy), immediatedelayed (a few weeks between mastectomy and reconstruction), or delayed (years

after mastectomy). Depending on the patient’s preference, disease status, and overall

treatment plan, options may include implants alone, implants plus biologic dermal

substitutes, or implants plus the patient’s own flaps.

RPCI plastic & reconstructive surgeons have expertise in breast reconstruction

using the Deep Inferior Epigastric Perforator (DIEP) flap, which uses skin and fat from

the patient’s abdomen, sparing the abdominal muscles. The DIEP flap is associated

with greater flexibility in shaping the breast mound, reduced pain and faster recovery,

and reduced risk for such complications as hernia.

• Autologous fat transfer, in which fat is harvested from multiple locations (the abdomen, for example) and used to fill concave deformities.

• Lymph node transplantation, a procedure that can reduce or eliminate the symptomsof lymphedema.

• Facial reanimation, to restore movement and improve appearance following paralysis related to injury, surgery, or illness.

• Vascularized bone flap and grafting, which speeds healing and preserves bone mass and strength.

• Peripheral nerve reconstruction, to correct such disorders as neuropathy resultingfrom nerve resection.

• Amelioration of complications related to orthopedic surgery, such as necrosis-related hardware exposure.

• Pelvic reconstruction after treatment for colorectal, vaginal, or cervical cancer.• Chest wall reconstruction.• Reconstruction of the oral cavity, floor of mouth, upper oral airway, and larynx.• Limb preservation or reconstruction following trauma or cancer surgery.

Roswell Park’s plastic & reconstructive surgeons provide a full menu of services to preserve or restore the function and/or

appearance of any region of the body. They work closely with surgical oncologists at RPCI as well as surgeons from outside

centers to solve a broad range of complex problems, including those related to cancer, trauma, pressure ulcers, and delayed

effects of chemotherapy or radiation treatment.

Head & Neck Reconstruction

In cases where excision of a tumor

in the head & neck area creates

extensive defects, the plastic &

reconstructive surgery team can

improve appearance and help

restore such functions as speech

and swallowing.

In the most severe cases—involving

the removal of bones from the jaw,

for example—the team may use

free flaps to transplant muscle, bone,

or skin from other parts of the body

to close and repair the site. Planning

the surgery with the aid of a 3-D

model of the jaw, the plastic &

reconstructive surgeons, along

with the maxillofacial prosthodontist,

can reconstruct jawbones and

restore dentition as well.

Trans-Oral Robotic SurgeryFor cancers of the throat and base of tongue, RPCI offers Trans-Oral

Robotic Surgery (TORS). TORS provides the potential for preserving

swallowing function and it may eliminate or reduce the need for

adjuvant radiation. It has been shown to reduce the need for open

surgery, minimize postoperative pain, and shorten recovery time,

as compared with more invasive procedures.

Working from an operating room console, the surgeon manipulates

three long, slim robotic "arms" capable of reaching deep into the

mouth and throat. A camera introduced by one of the arms transmits

magnified, three-dimensional images to the console, giving the

surgeon an unparalleled view of the surgical site for greater precision.

RPCI is a world leader in robotic surgery, and our Robotic Surgery

Center trains surgeons from across the U.S. and around the world.

Head & Neck SurgeryAdvanced Techniques Improve Disease Control, Speed Recovery, Preserve Quality of Life

RPCI is a world leader in robotic surgery, and our Robotic Surgery Centertrains surgeons from across the U.S. and around the world.

Radiation Medicine:Targeted Therapy and On-Time Treatment ScheduleTargeted radiation is usually part of the treatment plan for patients with squamous cell

carcinomas, which comprise the majority of head & neck cancers. Roswell Park offers

Intensity-Modulated Radiation Therapy (IMRT), Image-Guided Radiation Therapy (IGRT),

and Volumetric-Modulated Arc Therapy (VMAT), which zero in on the tumor site while

protecting healthy tissue from radiation exposure.

At Roswell Park, treatment is delivered by board-certified radiation oncologists. The

Radiation Medicine team also includes several PhD-trained, board-certified medical

physicists who continually monitor safety and quality-control standards.

But targeted therapy and clinical skill are only part of the equation for improving treat-

ment outcomes. To keep patients on track, RPCI's Radiation Medicine Department has

introduced a comprehensive support system that begins during the first week of radia-

tion therapy. Patients and their families are educated about the importance of schedule

adherence, and patients receive assistance with nutrition, psychosocial needs, pain

management, and other issues that may interfere with treatment.

Patients who cannot avoid missing a weekday appointment for radiation treatment

can take advantage of weekend appointments or make up the missed treatment with

two treatments in one day. This "shepherding" approach enables nearly 99% of head

& neck patients at RPCI to receive treatments on schedule, giving them the best

prospects for a cure.

Anurag Singh, MD, Radiation Oncology

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PDT has three effects:• It kills cancer cells directly.• It triggers anti-angiogenesis, shutting down the creation of new blood vessels that would otherwise feed the tumor.

• It activates the immune system, both at the tumor site and systemically, to destroy cancer cells throughout the body.

When appropriate, PDT can be administered for the treatment of precancerous

oral and oropharyngeal lesions. Because it largely spares healthy tissue, it

is unlikely to compromise speech or similar functions. In addition, because

it is nontoxic, patients can be re-treated as needed, and it does not affect

options for future treatment with other modalities.

RPCI developed PDT—which is used worldwide and FDA-approved for the

treatment of esophageal cancer and non-small cell lung cancer— and for

more than 20 years has been a world leader in its refinement.

Combined Modality Therapy for Head & Neck Malignancies

The Medical Approach: Access to Novel AgentsChemotherapy may be given either alone or in combination with radiation

therapy—either as the primary therapy or following surgery—for patients with

head & neck cancers. In addition to the standard chemotherapies, patients at

RPCI have access to a wide range of novel therapeutics, including tyrosine kinase

inhibitors, monoclonal antibodies, or immunotherapy agents, through phase I or

phase II clinical research studies (clinical trials).

About 90% of head & neck cancers are found to overexpress the epidermal

growth factor receptor (EGFR). RPCI offers cetuximab (Erbitux), an EGFR inhibitor,

for the treatment of metastatic disease.

Many patients treated at Roswell Park also have the option of enrolling on phase I

or phase II clinical research studies (clinical trials) of novel agents—including

targeted therapies—led by Roswell Park.

Radioactive Iodine Therapyfor Thyroid Cancer and Benign Thyroid DiseaseRoswell Park’s Nuclear Medicine Department provides radioactive

iodine therapy for post-surgical remnant ablation for some patients

with thyroid cancer or benign thyroid disease.

Photodynamic TherapyNontoxic, Three-Way Destruction of Cancer Cells

Yujie Zhao, MD, PhDMedical Oncology

Clinical Research StudiesCan Expand Treatment Options

Roswell Park's Clinical Research Services program expands treatment options for eligible patients by

giving them the opportunity to enroll in phase I or phase II clinical research studies of promising new

therapies. These studies undergo a rigorous internal and external approval process to ensure that

patient safety is the top priority.

Roswell Park patients participating in clinical studies were the first to benefit from such treatments

as the breast cancer drug Herceptin® and the leukemia drug Gleevec®, both of which proved to be

more effective than the standard of care at that time.

The Institute's Clinical Research Center, one of the nation's first to focus exclusively on cancer,

provides enhanced monitoring and a medical team experienced in the administration of

investigational therapies. It is supported by a dedicated Investigational Drug

Service staffed by clinical pharmacists and pharmacy technicians who

specialize in the drugs and agents used in clinical studies.

New clinical research studies open continually, including

studies focused on prevention. To search Head & Neck

studies currently enrolling patients at Roswell Park,

visit www.roswellpark.org/clinical-trials/list.

Head & neck patients at RPCI may be eligible to enroll in a clinical

research study of photodynamic therapy (PDT), a nontoxic treatment (not chemotherapy) that uses laser light to activate a light-sensitive

compound delivered intravenously.

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Head & neck cancers are medically complex: both the disease and its treatment can

have profound effects on not only the patient's overall health but also appearance;

ability to eat, swallow, and communicate; and psychological and emotional well-

being. From the time of diagnosis, the Dental Oncology & Maxillofacial Prosthetics

team plays an important role in developing a treatment plan aimed at protecting

the patient's longevity and quality of life. In partnership with the School of Dental

Medicine of the State University of New York at Buffalo, RPCI is developing a

Center of Excellence in Oral Oncology to serve the patients of New York State.

Surgery, chemotherapy, and radiation therapy can lead to infection, swelling or

peeling of intraoral tissues, the development of cavities, jaw stiffness, and pain.

All of these conditions may affect the patient's ability to complete treatment, and

thus are potentially life-threatening. Roswell Park dentists see patients before

treatment begins to evaluate their baseline oral health, and work closely with

other members of the medical team to prevent or manage problems that may

arise throughout the treatment process. They also educate patients about oral

hygiene and provide advice on dealing with any treatment side effects that develop.

The Maxillofacial Prosthetics team is part of the comprehensive Head and Neck

Oncology team and works closely with the head and neck surgeons for optimal

planning of reconstruction and rehabilitation. This collaboration is critical to

achieving the ultimate reconstructive goal of replacing “like with like.” Applying

this principle, it is possible to replace jawbones that are removed during cancer

surgery using bone harvested from other parts of the body, microvascular free

tissue transfer, implants, and dental rehabilitation—often during the initial cancer

surgery. This approach allows faster recovery and shorter rehabilitation time.

Rehabilitation ServiceRPCI’s Head & Neck Rehabilitation Service is distinguished by the range

of services it provides. It brings together experts in speech, swallowing,

dietetics and maxillofacial prosthodontics with the goal of evaluating and

managing the patient comprehensively to maximize rehabilitation.

Roswell Park patients who have been diagnosed with head & neck

cancers have access to a full complement of support services specific

to their needs during and after treatment, including:

• maxillofacial prosthetics• physical therapy• speech therapy• nutrition counseling• clinical genetics counseling• social work support• pain management

Who is eligible for consultation with this service?• Anyone who has undergone treatment for head & neck cancer

and has residual functional impairments

• Anyone who was recently diagnosed with head & neck cancer,

to plan the optimal post-treatment rehabilitation

• Anyone who is undergoing treatment for head & neck cancer

Physicians who would like more information about Roswell Park’s

Head & Neck Rehabilitation Service may contact Vishal Gupta, MD, at 716-845-3158.

Speech-Language PathologyRPCI’s Speech-Language Pathology team diagnoses and treats problems

related to communication, swallowing, and airway-management issues that

patients may experience as a result of head & neck cancer or its treatment.

Videofluoroscopic Swallowing Studies (VFSS) and laryngeal endoscopy are

among the procedures used to determine a patient’s ability to eat safely by

mouth. The team also provides pre-surgery and pre-radiation counseling to

help patients prepare for their treatment and recovery.

Clinical Genetic CounselingIn very rare cases, patients have an inherited mutation that increases

their risk for thyroid tumors. In some cases, if appropriate, they may

decide to undergo prophylactic surgery or opt for active surveillance

(watchful waiting) so intervention can begin if the situation warrants.

For patients with a personal and/or family history of thyroid tumors,

the Roswell Park Clinical Genetics Service can provide a cancer risk

assessment to help determine the potential hereditary risk in the

family. This includes discussion of associated cancer risks and medical

management recommendations, considerations for genetic testing and

interpretation of genetic test results. Genetic counseling is recom-

mended for all patients diagnosed with medullary thyroid cancer.

Patient Navigators & SupportPatients can rely on patient navigators to assist in managing appointments,

understanding medical terminology, arranging transportation for medical

appointments, and a range of related issues.

Newly diagnosed patients benefit from regular contact with fellow

survivors. RPCI offers two sources of support: an RPCI-sponsored

a chapter of SPOHNC (Support for People with Oral, Head and Neck

Cancer) and a new program offered through the Radiation Medicine

Department that connects patients with volunteer survivors of

head & neck cancer—often matched by age, gender, and disease

site and stage.

Because patients with head and neck cancer are at high risk of disease

recurrence, they should be followed closely over the long term after

treatment has been completed.

RPCI’s Comprehensive Head & Neck Rehabilitation Service

Coordinated Care, Greater Convenience

RPCI delivers support services in one location, providinggreater convenience, coordination of care, and close communication among the various providers involved inthe patient's care.

Dental Oncology & Maxillofacial ProstheticsPreserving Quality of Life

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• Combining chemotherapy drugs with either monoclonal antibodies or small-molecule

drugs to treat metastatic squamous cell cancers of the head & neck.

• The use of HPPH, a new chlorophyll-based photosensitizer developed at Roswell

Park, in photodynamic therapy (PDT — see p. 9) for treatment of dysplasia and

early-stage carcinomas of the larynx, oral cavity, and/or oropharynx.

• The use of the diabetes drug pioglitazone for treating premalignant oral lesions.

• The safety and efficacy of the varicella zoster immune globulin vaccine to prevent

varicella zoster in patients at risk for the disease.

To search Head & Neck clinical research studies currently enrolling patients at

Roswell Park, visit www.roswellpark.org/clinical-trials/list.

Research Drives Better Care, Improved OutcomesTranslational research conducted at Roswell Park and partner institutions helps RPCI speedthe most promising diagnostic methods, treatments, and practices to our patients.

Diagnosis / Prognosis

Jointly with the Mazumdar-Shaw CancerCenter in Bangalore, India, the RPCI Head& Neck Oncology Research Program is

working to develop:

• A mobile app to help community dental surgeons identify suspicious oral lesions

in high-risk patients.

• A saliva-based test to screen for oral cancer and provide prognostic information.

• An intraoperative molecular assay system to confirm lymph node metastasis in

head & neck squamous cell carcinoma, to avoid overtreatment and such related

morbidities as lymphedema.

• A panel of biomarkers to identify laryngeal/pharyngeal cancer patients whose

genetic profiles suggest their likely response to chemoradiation as an organ-

preserving alternative to surgery.

• Isolation and identification of treatment-resistance pathways in oral cancer stem

cells, to inform treatment choices and suggest novel therapeutic targets.

Treatment

Clinical research studies provide accessto many novel treatments. Studies currently underway are evaluating:

In partnership with the State University of New York at Buffalo and the Daemen College Center for Wound-Healing Research, Roswell Park is

working to identify the causes of chronic wounds and develop strategies to promote healing. The team aims to create the first-ever clinical

test to determine—soon after a wound develops—whether or not healing is progressing normally, so intervention can occur early on if

necessary. The test will be based on Protein-Imprinted Xerogels with Integrated Emission Sites (PIXIES), an instrument designed to survey

wounds for specific proteins identified by the team as prevalent in wounds that fail to heal.

Recovery

Surgical Oncology FellowshipIn Head & Neck

Focusing exclusively on cancer,Roswell Park Cancer Institute is at the heart of the rapidly expandingBuffalo Niagara Medical Campus,home to the region's premier institutions engaged in health care, medical education, and life sciences research. In this excitingatmosphere of discovery and innovation, fellows learn from worldleaders in oncology and related fields.

The application deadline is July 1, and applicants are advised to begin the process approximately one yearprior to the anticipated date of enrollment. Interviews are usually held in late summer or early fall. For further

details and an application, visit www.roswellpark.edu/education/clinical-fellowships or www.ahns.info.

Application Deadline

Head & Neck fellows enjoy several advantages at RPCI:• The fellowship is an official American Head and Neck Society Fellowship in

Advanced Training in Head and Neck Oncologic Surgery.

• Fellows learn all aspects of head and neck surgery, including advanced resection

techniques, microvascular reconstruction, skull base surgery, and Trans-Oral

Robotic Surgery (TORS).

• Equipped with two da Vinci® robotic surgical systems, RPCI is a world leader in

robotic surgery and offers TORS as a treatment option for patients with head &

neck cancers. Khurshid Guru, MD, Director of Robotic Surgery, is co-inventor ofthe Robotic Surgical Simulation System (RoSS), a “flight simulator" for training in

robotic surgery, drawing surgeons from around the world who want to acquire or

refine robotic-surgery skills.

• Fellows also build a broad base of knowledge of tumor biology, molecular genetics,

epidemiology, biostatistics, radiation principles, protocol development, screening

and early detection, staging, multidisciplinary treatment, pain management, and

end-of-life issues. This multi-faceted approach to training enables many Head &

Neck fellows to go on to positions that combine their academic, research, and

clinical interests.

• Fellows attend weekly meetings that bring together faculty from several disciplines

to discuss new and complex cases, enabling them to experience firsthand the

value of RPCI's multidisciplinary approach to patient care.

Surgical oncology fellows at RPCI develop andstrengthen their skills in operative technique and surgical decision-making. Prospective fellows mayapply for either a one-year clinical or two-year clinical and research fellowship in Head and NeckSurgery and Oncology. The program comprises at least 12 months of clinical rotations covering all aspects of contemporary head and neck surgery, microvascular surgical reconstruction, and oncology.